AB1388 CHARACTERISTICS ASSOCIATED WITH MYCHART ACTIVATION AND REASONS FOR NON-USE AMONG RHEUMATOLOGY CLINIC PATIENTS
Authors: C. Siegel, A. Bass, D. Jannat-Khah, O. Bruce, J. Olmscheid, N. Ghosh, S. E. Sattui, M. Schwartzman, D. Zisa, A. Lakhanpal, K. Yip, L. Yue, J. Aizer, J. Berman
Journal: Annals of the Rheumatic Diseases (2022)

Background Electronic patient portals, such as MyChart by Epic, allow patients to view their medical records, request medication refills, and communicate with their health care providers. Factors associated with portal use include being younger, female, White, having private insurance, and having chronic illness. 1 The Hospital for Special Surgery (HSS) rheumatology clinic serves primarily patients with public insurance (Medicaid, which insures low-income adults, and Medicare, which insures adults &gt;65 years old and those with eligible chronic illness/disability). These patients may be at increased risk for poor health outcomes due to clinical and socioeconomic factors and they are less likely to use MyChart than patients seen in HSS private practices. Increased MyChart use may benefit this high-risk group and improve health equity. Objectives This study aims to identify characteristics associated with MyChart activation and reasons for its underutilization among patients seen in the HSS rheumatology clinic. Methods We identified all patients aged ≥ 18 years seen in the HSS rheumatology clinic at least twice between January 15, 2019 and January 14, 2021, with at least one visit occurring between July 15, 2020 and January 14, 2021. MyChart status (active vs. inactive) and sociodemographic and clinical variables were extracted from the electronic health record (EHR). We used chi-square tests and t-tests to compare characteristics between patients with and without active MyChart; p-value &lt;0.05 was considered significant (Table 1). In addition, 10 rheumatology fellows were prompted on 3 occasions over 6 weeks to informally survey their own clinic patients with inactive MyChart accounts by asking: “What is your primary reason for not using MyChart?”. Table 1. Baseline Characteristics of Hospital for Special Surgery Rheumatology Clinic Patients Stratified by MyChart Activation Status MyChart Active (N=726 ) MyChart Inactive (N=501 ) p-value Age, yrs - Mean (SD) 50.3 (15.6) 60.0 (15.3) &lt;0.01 Female - N (%) 601 (82.8) 412 (82.2) 0.80 Race - N (%) 0.37 •White/Caucasian 275 (37.9) 184 (36.7) •Black/African American 185 (25.5) 135 (27.0) •Asian 58 (8.0) 25 (5.0) •Other 189 (26.0) 145 (28.9) •Unknown 18 (2.5) 11 (2.2) Ethnicity - N (%) 0.27 •Hispanic/Latino 294 (40.5) 226 (45.1) •Not Hispanic/Latino 422 (58.1) 268 (53.5) •Unknown 10 (1.4) 7 (1.4) Preferred language - N (%) &lt;0.01 •English 611 (84.2) 332 (66.3) •Spanish 72 (9.9) 134 (26.8) •Other 43 (5.9) 35 (7.0) Needs interpreter - N (%) 106 (14.6) 156 (31.1) &lt;0.01 Results There were 1,227 patients included (93.2% with Medicaid and/or Medicare insurance). Compared to patients with inactive MyChart (42.9%), those with active MyChart (57.1%) were younger (50.3 ± 15.6 vs. 60.0 ± 15.3 years, p&lt;0.01). The majority of patients in both groups was female. There was no significant difference in race or ethnicity between groups. Patients without active MyChart were less likely to identify English as their preferred language and more likely to require an interpreter for clinic visits (Table 1). The rheumatology fellows collectively asked 16 clinic patients with inactive MyChart their primary reason for non-use. The most commonly cited reason was difficulty using the technology (n=8; 50.0%); others included visual impairment (n=2; 12.5%), preference for using the telephone (n=2; 12.5%), concerns about security/spam (n=2; 12.5%), not having a smart phone/computer (n=1; 6.3%), and having a language barrier (n=1; 6.3%). Conclusion In the HSS rheumatology clinic, patients who did not have active MyChart were older and less likely to be English-speaking than those who did. The most common barrier to MyChart use reported by patients was difficulty with the technology. This pilot data suggests a need for interventions to facilitate patient-provider communication, specifically targeting older and non-English-speaking rheumatology clinic patients, with the goal of advancing patient engagement and health equity. References [1]Ancker JS, et al. J Gen Intern Med. 2011 June 7. doi: 10.1007/s11606-011-1749-y. Disclosure of Interests Caroline Siegel: None declared, Anne Bass: None declared, Deanna Jannat-Khah Shareholder of: AstraZeneca, Walgreens, Cytodyn, Omar Bruce: None declared, Justin Olmscheid: None declared, Nilasha Ghosh: None declared, Sebastian E. Sattui Grant/research support from: AstraZeneca, Monica Schwartzman: None declared, Diane Zisa: None declared, Amit Lakhanpal: None declared, Kevin Yip: None declared, Linda Yue: None declared, Juliet Aizer Grant/research support from: Pfizer and Lilly, Jessica Berman: None declared